Part 2 – Employer Role in Managing a Workers Comp Claim

As an employer, you often hear the recommendation “stay involved in your workers’ compensation claims.” That is great advice, but way too often it’s where the discussion ends without any explanation as to what “staying involved” means.

 

The employer’s involvement in the workers’ comp claim begins before the injury occurs and ends when the employee is back at work, fully recovered from the injury. Let’s first look at two phases of employer’s involvement in the workers’ comp claim.

 

The four phases are:

 

  1. Pre-injury process
  2. The injury occurrence
  3. The claim process
  4. The claim settlement

 

Phases 1 & 2 covered in:

Part 1 – Employer Role in Managing a Workers Comp Claim

 

 

3. The Claim Process

 

Too many employers allow their involvement in the workers’ comp claim to end when they send the employee to the doctor. That is a bad mistake and will result in a steady increase in the amount of workers comp insurance premiums. The employer needs to have an established post injury process. It should include:

 

  • Report the claim to the insurer, third-party administrator or self-insured claims office immediately. The supervisor or your workers’ comp claims coordinator should be reporting the claim to the claims office while the employee is still en route to the medical provider.
  • Complete the Employer’s First Report of Injury and any other state required paperwork on the claim.   If the injury is severe and the employee will be unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.
  • Advise the claims office of the claimant’s prior history of workers comp claims. The adjuster’s approach to the claim varies significantly between the employee who never had a prior workers comp claim and the employee who has had 15 workers comp claims in the last ten years.
  • Review your transitional duty program and find a job the employee can do within the treating physician’s restrictions.
  • Be sure the employee’s supervisor (and co-workers if needed) are available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation as needed.
  • Don’t alienate the employee – show empathy to the employee. When employees feel the company does not care about them and their injury and the company owes them, the claim will get ugly when employees feel it is time to stick it to the employer.
  • Maintain an open dialogue – call the employee at home to show your concern and to offer assistance in processing the workers’ comp claim with the insurance company. Address any employee problems or issues right away. Also, call the employee on a regular basis until s/he is back at work.
  • If you are contacted by an attorney representing the employee, notify the claims adjuster immediately.
  • Immediately dispute any invalid or fraudulent claim.
  • If the employee has a questionable claim or a subjective claim for neck or back injuries, and immediately goes to the television advertising workers comp attorney or a plaintiff’s attorney-oriented doctor known for excessive disability ratings, advise the employee immediately that you intend to fight the claim as the attorney and/or doctor has a history of inflated claims
  • Monitor the state filings by the adjuster and any other claim related paperwork
  • Monitor the Workers Compensation Board decisions – that means, reading them carefully, not just filing them away. Be ready to protest any finding or order you feel is unfair to you as the employer as all decisions have time limits for disputing the decision, with some time limits as short as 15 days.
  • Monitor the medical progress reports to be sure the treatment is appropriate – for example – no physical therapy for the low back when the injury is a cut finger.
  • Always advise the adjuster when the employee returns to work – the same day.

 

 

4. The Claim Settlement

 

Normally, it is up to the adjuster to negotiate the settlement of the workers’ comp claim. However, there will be occasions when the employer needs to be involved in the settlement discussions. This would include:

 

  • Working with structured settlement consultant and professional administrator in settlement discussion if appropriate.
  • Attending depositions and hearings.
  • Attending the settlement conference (with settlement authority if you are self-insured).
  • Working with the vocational rehabilitation specialist to accommodate the employee’s return to work if there are any ADA concerns.
  • Providing rehabilitation training if necessary.

 

 

What You Cannot Do

 

Occasionally employers go overboard in their efforts to control the cost of workers comp claims. There are some actions you cannot do including:

 

  1. Going without workers compensation insurance. This is a criminal offense in most states, you will pay fines, you will pay the claim out of company funds and you could end up paying your own cost to defend a lawsuit from the injured employee.
  2. You cannot terminate the employee for filing a workers comp claim.
  3. You cannot refuse to hire an employee solely because of prior workers comp claim history (unless the prior injury(s) makes it impossible for the employee to do the job under consideration).
  4. You cannot charge an employee for any part of the workers’ comp premium.
  5. You cannot pay the small claims out of company funds and not report them to the workers’ comp insurer.

 

By staying involved in the workers’ comp claim from before the claim happens to the time the claim is concluded, you will have a strong, positive impact on the cost of your workers’ compensation insurance.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

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